Innovative Models of Care - Walgreens Healthcare Clinics


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Innovative Models of Care
Walgreens Healthcare Clinics
Sandra Ryan, Chief NP Officer and Clinical Advocate Take Care Health Systems

Mano y Corazón Binational Conference of Multicultural Health Care Solutions, El Paso, Texas, September 27-28, 2013

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  • Role of NP’s in Retail Health care in validating retail health care as a innovative healthcare solutionNeed for leadership in fostering collaboration in the industry to ensure quality of care and patient safetyRole of a Chief Nurse Practitioner Officer, Future of Nursing Report, Robert Wood Johnson Foundation, College of Physicians, and the creation of a NP centric organization and a nursing leadership structure within Take Care Health SystemsImportance of NP’s being involved and the role that they play in the future and in the current healthcare environmentAffordable Care Act, Retail Clinics and Nurse Practitioners in healthcare nursing leadership
  • Note to presenter: Outline Walgreens strong foundation – impressive retail footprint and multitude of pharmacy, health and wellness assets.Speaking points (in addition to the slide):Walgreens plays a critical role in the health and well-being of our communities – and business partners – nationwide. We’re on the best corners across America.Our collection of assets expands beyond our store’s doors and into the community to hospital, specialty centers and employer campus settings, strategically positioning us close to the customer.
  • Our assets complement market need and extend their footprint/medical home
  • Innovative Models of Care - Walgreens Healthcare Clinics

    1. 1. Innovative Models of Care Walgreens Healthcare Clinics Sandra Ryan, Chief NP Officer and Clinical Advocate Take Care Health Systems ©2013 Walgreen Co. All rights reserved.
    2. 2. Agenda • Overview of Walgreens as a Health and Daily Living Destination • Evolution of the Convenient Care Industry/Retail Clinics • Role of Convenient Care and the NP in the Retail Clinic • Overview of the Role of NP Leadership • Future Role of the Nurse Practitioners in Healthcare
    3. 3. •Walgreens Well Experience: •Transforming the traditional drugstore to a health and daily living destination •Vision: To be for everyone in America – the first choice for health and daily living, owning the strategic territory of ―well.‖
    4. 4. Walgreens Plays a Critical Wellness Role in Communities Across the Country • With more than 8,500 multichannel points of care, Walgreens gives you the power of a national footprint with the reassurance of a personalized local presence • Walgreens is the largest national provider of immunizations, second only to the US government • Walgreens is the largest pharmacy retailer in the country, filling more than 21% of all scripts – more than any other pharmacy network • 6.1 million customers visit Walgreens everyday • Over 800 Clinics, in retail health outlets and worksite-based health and wellness centers, many in ―med-deserts‖ ©2013 Walgreen Co. All rights reserved.4
    5. 5. Walgreens Healthcare Patient Touchpoints  180 Hospital Outpatient Pharmacies in major institutions such as Yale and Northwestern  WellTransitionsTM discharge solution significantly reduces hospital readmissions Hospital System Solutions National Network of Retail Pharmacies 8,200+ pharmacies employing 70,000+ trusted health care professionals  Located within 3 miles of ~65% of Americans = 6 M customers each day Specialty Pharmacy  #4 in the Industry-17 integrated Specialty Health Programs  700 HIV Centers of Excellence Infusion Services  #1 infusion provider with 75 Rx & 100 Alternate Treatment Sites in 36 states  1,400 nurses deliver infusions either at home or at our sites Retail Clinics Employer Health Centers  375 On-site health centers at employer locations; 40+ years experience  160+ employer clients in 45 states; serving ~10 M employees at work  400 Healthcare Health Clinics located in Walgreens stores in 19 states + DC  1,500 NPs and 40 PAs; every clinic has a collaborating physician  Chronic and Acute disease management programs • 5 ©2013 Walgreen Co. All rights reserved. Confidential and proprietary; should not be re-produced or re-distributed. •DRAFT- ACCOUNTABLE CARE SERVICES
    6. 6. ©2013 Walgreen Co. All rights reserved. 6 Retail Industry-Healthcare Clinics
    7. 7. The Problem-A Broken Healthcare System Primary Care — Will It Survive? Thomas Bodenheimer, M.D. •“Family Medicine cannot fully succeed, nor will the needs of the public be met, without fundamental changes in the U.S. health care system.”
    8. 8. Facts  50 million Americans are uninsured, including 1 in every 8 children. (Census Bureau, 2010)  70% of Americans report they can’t get same-day appointments with their PCP. (Commonwealth Fund 2007)  29% of Medicare recipients (11.6 million people) have a hard time finding a PCP who accepts their insurance. (Commonwealth Fund 2007)  30% of Americans lack a regular source of primary care. (Commonwealth Fund 2009)  Almost half of all emergency room visits were non-emergent in nature or otherwise treatable in primary care settings. (Desypher Analytical Services, 2010) ©2013 Walgreen Co. All rights reserved. 8
    9. 9. Healthcare Access is in Crisis 9©2013 Walgreen Co. All rights reserved. • Limited access to routine and preventive care. • Millions of consumers do not have an established physician relationship or health insurance. • Health care costs are rising at unsustainable rates. Healthcare cost estimated to be 20+% of the GDP by 2020. • Consumers are demanding convenience. • These issues will worsen as the primary care shortage grows.
    10. 10. Disrupting the Traditional Model ©2013 Walgreen Co. All rights reserved. 10 Convenient Care/ Retail Care has been termed a ―disruptive innovation.‖
    11. 11. More than 390 Locations in 34 Markets, 21 States ©2013 Walgreen Co. All rights reserved. 11 - • Atlanta • Boulder • Chicago • Cincinnati • Cleveland • Colorado Springs • Columbus • Denver • Ft Lauderdale • Houston • Indianapolis • Jacksonville • Kansas City • Knoxville • Las Vegas • Memphis • Miami • Milwaukee • Nashville • New Orleans • New York City • Orlando • Philadelphia • Phoenix • Pittsburgh • St. Louis • Tampa • Topeka • Tucson • Washington DC
    12. 12. Industry Growth 12 • Growth in the number of clinics is anticipated in the coming years (Deloitte Center for Health Solutions, 2009) • Scope of services is being expanded with an eye towards disease prevention and chronic disease monitoring and management. • More hospitals and health systems now operate clinics than non- hospital companies, though the majority of individual clinics are still operated by non-hospital companies. • Growth among hospitals is largely due to perceived benefits of the relationship in supplementing and extending existing care (RAND, 2010). ©2013 Walgreen Co. All rights reserved.
    13. 13. Personalized Quality Healthcare Made Easy 13©2013 Walgreen Co. All rights reserved.  High-Quality • Evidence-based • Nurse Practitioners • Streamlined technology, E-prescribing capabilities, transparency of quality metrics  Convenient • No appointment needed but can schedule one • Open 7 days a week – evening, weekend, and holiday hours  Affordable • Lower-cost access to care • Most major insurance plans accepted • Transparent Pricing
    14. 14. Delivering a Patient Centric Experience 14 ©2013 Walgreen Co. All rights reserved. • 260+ square feet • Two exam rooms, with exam tables • Restroom facilities nearby • Most clinics conveniently located across from the pharmacy • Professionally outfitted with state-of- the-art technology and medical equipment • Electronic sign-in kiosks/LCD • Patient queue, with wait time visibility • Electronic Health Records
    15. 15. Growing Range of Services 15©2013 Walgreen Co. All rights reserved. Examples • Flu shots • Hepatitis A & B • Meningitis • MMR (Measles, Mumps, Rubella) • Tdap (Tetanus, Diphtheria, Pertussis) • Varicella (Chicken Pox) • Zostavax (Shingles) • Physicals (camp and sport) • Health screenings HRA’s • Medicare Wellness Exams Examples • High Blood Pressure • Specialty Injection Services • Asthma • Cardiovascular conditions • Chronic bronchitis • Diabetes • High Cholesterol • Osteoporosis Examples • Strep throat • Sinus infection • Bronchitis • Ear infections • Urinary tract infections • Seasonal allergies • Minor burns • Sprains/strains • Skin rashes • Cold and mouth sores • Tick/insect bites and stings • Wart removal
    16. 16. Exceptional Patient Experience 16©2013 Walgreen Co. All rights reserved. •ACCESS •TRANSPARENCY  Wait times, patient satisfaction, and quality metrics transparency via to guide patient choice  Cash prices, as well as insurance plans accepted, available via in-clinic signage and website - Most insurance plans accepted, including Medicaid - Affordable costs for cash paying patients • Clinics can serve as a cost-effective alternative for overflow, after hours, and non-emergent needs • Open 7 days a week, including weeknights • Walk-ins welcome and appointments available
    17. 17. Exceptional Patient Experience 17©2013 Walgreen Co. All rights reserved. •SIMPLICITY •PATIENT SATISFACTION • A simple, paperless check-in process and clear information about estimated wait time • E-prescribing to allow access to patients’ pharmacy of choice • On line and in clinic appointment scheduling available for patients • Patient satisfaction is in the top 10% of Gallup Consulting’s consumer database • Follow-up phone call within 48 hours of their visit • Health Care Clinic strongly engages more than three out of every four patients, while the typical company that works with Gallup strongly engages fewer than one in four of their patients • More than 95% of patients agree that ―the Nurse Practitioner/Physician Assistant spent enough time with me‖ and ―health matters were explained in a way that was easy to understand “
    18. 18. Clinical Excellence 18©2013 Walgreen Co. All rights reserved. •BEST-IN- CLASS •PROCESSES •WELL- TRAINED •CLINICAL STAFF • Use of evidence-based frameworks and expert review of clinical policies • Quality benchmarked against national standards, such as HEDIS • Clinic exceeds national HEDIS benchmarks in measured categories • Chart review process, facilitated by EMR, includes both peer review and Collaborating Physician review • Clinicians credentialed in accordance with NCQA guidelines • Enhanced certification and education of our clinicians • Accreditation Association for Ambulatory Health Care (AAAHC) accredited EVIDENCE- BASED RESOURCES  American Academy of Pediatrics. Pediatric Clinical Practice Guidelines & Policies (2012)  Red Book Online American Academy of Pediatrics (2012)  Harriet Lane Handbook (2012) Pediatric Book  DynaMed Online (2012)  Veterans Affair/DoD Clinical Practice Guidelines Online  Epidemiology & Prevention of Vaccine- Preventable Diseases, CDC (2012)  Sanford Guide to Antimicrobial Therapy (2013) Antimicrobial Therapy Incorporated  Griffith’s Education for Patients (8th Edition, 2011)  Skin Disease: Diagnosis and Treatment by T. Habif (2011)  Epocrates Interactive Online Premium (2012)  Cash, J.C., & Glass, C.A., Family Practice Guidelines, Second Edition  Yellow Book For Travel Vaccines, CDC, 2012
    19. 19. • 13.7-27.1% of all ED visits could take place at alternative sites. • Potential $4.4 billion in annual cost savings. An Alternative to the ED
    20. 20. Improving Access As many as 40% of clinic patients report not having a PCP (Mehrotra et al. 2011) Some hospital systems report their retail clinics are the largest entry point into their healthcare system. (Mehrotra et al. 2011) ~12 to 14% of all ED visits can be seen at convenient care clinics (Weinick et al. 2010; Mehrotra et al. 2008). 93% of patients report highly on the convenience (Wall Street Journal/Harris Interactive 2008). Nearly 30% of the U.S. population lives within a ten-minute drive of a clinic (Rudavsky et al. 2008).
    21. 21. Decreasing Costs • Retail clinics reduced ER use and costs for pediatric population, and reduced admissions and outpatient costs for patients with chronic illnesses (Parente n.d.) • Costs of care at a convenient care clinic are significantly lower than those at an urgent care center, primary care office, or emergency department (Mehrotra et al. 2009; Thygeson et al. 2008). • Blue Cross and Blue Shield of Minnesota eliminated co-pays for enrollees who used a clinic, citing $1.2 million in cost savings (Minneapolis/St. Paul Business Journal 2008). • Retail clinics have a return visit rate comparable with standard medical offices - care is high quality and does not generate additional follow up utilization. (Rohner et al. 2012)
    22. 22. Peer Reviewed Quality Outcomes Convenient care clinic providers adhere to evidence-based practice guidelines and exceed national benchmarks (Jacoby et al. 2010; Woodburn et al. 2007). Quality scores and rates of preventive care offered are similar for convenient care clinics as for other delivery settings (Mehrotra et al. 2009). • Convenient care clinics had a 92.72% compliance with quality measure for appropriate testing of children with pharyngitis vs HEDIS average of 74.7%; they also had an 88.35% compliance score for appropriate testing of children with URI vs HEDIS average of 83.5%. (Jacoby et al. 2010)
    23. 23. Role of Nursing in Retail Industry ©2013 Walgreen Co. All rights reserved. 23
    24. 24. Chief Nurse Practitioner Officer 24©2013 Walgreen Co. All rights reserved.  Roots in military corps concept: Nursing is its own profession  1st in Retail Clinic industry Executive voice of the NP—First NP leadership track in industry: • Clinical and Business leaders - Design work-environment to meet patient and provider needs - Develop proprietary EMR made for NPs - Create shared governance model from the start - Emphasis on quality - Nursing leadership development  Challenges: • Bridging gap between clinical and business • Regulatory constraints
    25. 25. Visibility For NP’s National representative of NPs for CCA • Creation of Quality and Safety Standards and Recommended Practices • Implementation of independent certification program for CCA members • Legislative representation to address role of NPs in retail model nationally • Gaining visibility in the media and among third-party researchers as a valuable source • Founding National Convenient Care Clinic Week; integrating convenient care into the national dialogue about healthcare and healthcare reform • Launching the CCA Clinician Portal to support and engage clinic providers • Establishing partnerships with major national publications; • Standardization of image of NPs in the retail industry Robert Wood Johnson Executive Nurse Fellowship Fellow of the College of Physicians Philadelphia
    26. 26. ©2013 Walgreen Co. All rights reserved. 26 Future of Retail and Nursing
    27. 27. We have the wind beneath our feet !! 27©2013 Walgreen Co. All rights reserved. Affordable Care Act • In March 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA), into law. The law makes preventive care accessible and affordable for many Americans. While some provisions of the law have already taken effect, many more provisions will be implemented in the coming years. • Enrollment begins October 1, 2013 for coverage beginning January 1, 2014 (U.S. Department of Health and Human Services).
    28. 28. Report Recommendations: Nurses should practice to the full extent of their education and training Services offered at retail clinics allows for nurses to practice to the fullest extent of their education and training within a retail setting.  Acute care  Preventive & wellness care  Chronic disease diagnosis & management •The Future of Nursing- IOM
    29. 29. National Governors Report 30 The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care December 20, 2012 States could increase access to primary care for their residents by consider easing their scope of practice restrictions and modifying their reimbursement policies to increase the role of nurse practitioners in providing primary care Reviews academic and policy-oriented literature and state rules governing nurse practitioners’ scope of practice to examine the extent to which: • Scope of practice rules, licensure and other conditional requirements vary across states; • States’ rules and requirements deviate from evidence-based research of appropriate activities for nurse practitioners; and • Changes to state scope of practice laws and regulations affect access to health care and its quality. ©2013 Walgreen Co. All rights reserved.
    30. 30. Current Legislative Environment: What it means to the NP Role 31©2013 Walgreen Co. All rights reserved.  Need for increased access: 30 +million more insured lives • Innovative models to address Physician shortage - More Nurse-Managed Healthcare Centers - Innovative models with all electronic, interoperable processes  NPs are positioned to educate and implement wellness and preventive medicine – holistic care  Quality: Accountable Care organizations (ACO’s) • Rewards provider-led organizations that take responsibility for the costs and quality of care received by their patients over time. • Will see increased partnering between health groups, including collaboration with NPs  Retail clinics engage in creative partnerships (employers, community health centers, private sector, payors  Federal Funding: Nursing education grants and loan programs to strengthen nurse training programs GNE
    31. 31. Future is BRIGHT for Patients and NP’s 32 Bracing for Obamacare: Nurse practitioners fill doc shortage gap Aug. 9, 2013 This is the first story in NBC's series "Quest for Care" exploring the shortage of health care providers as the Affordable Care Act rolls out. August 14, 2013 Nurse Practitioners Seek Right To Treat Patients on Their Own Health Professionals in Five States Fight to Shed Doctors' Oversight ©2013 Walgreen Co. All rights reserved.
    32. 32. Change is the Future…our Role From fee for service to value based programs, from face to face and the potential for telemedicine, from independent primary care practices to systems and from encounter based medicine to person based health. We need to: • Use Health Information to manage and coordinate care • Utilize all health professionals to their fullest extent • Collaborate to integrate services • Help other to Navigate the Change-Stay Patient Centerd • Strive for Healthy communities • Look to innovate to accelerate the pace of change Tipple Aim Better Care, Better Health, Lower Cost It’s time to look beyond the past, think about the present and be about the future •*Photo courtesy of Keith Green DDS Family Dentistry
    33. 33. The FUTURE 34 ©2013 Walgreen Co. All rights reserved. ― Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure…” It is our light not our darkness that most frightens we let our own light shine we unconsciously give other people permission to do the same.‖ Nelson Mandela
    34. 34. The END THE BEGINNING! ©2013 Walgreen Co. All rights reserved. 35